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To Eat or Not to Eat? A Review of Current Practices Regarding Food in Labor. CURRENT ANESTHESIOLOGY REPORTS 2023. [DOI: 10.1007/s40140-023-00549-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Fiszer E, Ebrahimoff M, Axelrod M, Ioscovich A, Weiniger CF. A multicenter interdisciplinary survey of practices and opinions regarding oral intake during labor. Int J Obstet Anesth 2022; 52:103598. [PMID: 36174309 DOI: 10.1016/j.ijoa.2022.103598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 06/14/2022] [Accepted: 08/31/2022] [Indexed: 10/31/2022]
Abstract
INTRODUCTION Different society guidelines diverge regarding oral intake in labor. Our goal was to assess practices and opinions in Israeli labor and delivery units, comparing different disciplines. METHODS An anonymous Google Forms survey was sent to anesthesiologists, obstetricians and midwives in all Israeli labor and delivery units. RESULTS Responses were collected from all 27 labor and delivery units contacted, with a total of 501 respondents comprising 161 anesthesiologists, 102 obstetricians and 238 midwives. Forty-eight per cent stated there were no institutional guidelines for oral intake. The most common oral intake permitted was light food (60%). Midwives were significantly more likely than anesthesiologists and obstetricians to consider that women who are both low risk for cesarean delivery (P <0.00001) and high risk for cesarean delivery (P=0.001) should eat. Epidural analgesia did not impact recommendations regarding oral intake. The most common reasons for restricting oral intake were obstetric. Sixty-two per cent identified aspiration as the main risk associated with eating during labor, but 19% of midwives compared with 4% of anesthesiologists and obstetricians stated there were no risks (P <0.00001). The annual delivery volume of the unit did not impact staff practices. CONCLUSIONS There was a discrepancy between opinions and practices across all disciplines. Permissive practices identified in this survey should be addressed to find the safe middle ground between restrictive and permissive policies for low- and high-risk women.
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Affiliation(s)
- E Fiszer
- Department of Anesthesia, Intensive Care and Pain, Tel-Aviv Sourasky Medical Center and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - M Ebrahimoff
- Department of Obstetrics and Gynecology, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - M Axelrod
- Department of Obstetrics and Gynecology, Sheba Medical Center, Ramat Gan, Israel
| | - A Ioscovich
- Department of Anesthesia, Intensive Care and Pain, Shaare Zedek Medical Center, Jerusalem, Israel
| | - C F Weiniger
- Department of Anesthesia, Intensive Care and Pain, Tel-Aviv Sourasky Medical Center and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Fiszer E, Aptekman B, Baar Y, Weiniger CF. The effect of high-dose versus low-dose epidural fentanyl on gastric emptying in nonfasted parturients: A double-blinded randomised controlled trial. Eur J Anaesthesiol 2022; 39:50-57. [PMID: 33852498 DOI: 10.1097/eja.0000000000001514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Epidural fentanyl doses above 100 μg have been shown, using the paracetamol absorption test, to reduce gastric emptying in fasted labouring women. OBJECTIVE To investigate the effect of fentanyl dose on gastric emptying in nonfasted labouring women using gastric ultrasonography. DESIGN A double-blinded randomised controlled study. SETTING A tertiary medical centre in Tel Aviv, Israel between 30 July 2020 and 11 October 2020. PATIENTS Eighty labouring women with cervical dilation 5 cm or less, at least 18 years age, at least 37 weeks gestation with a singleton pregnancy and cephalad foetus. INTERVENTIONS Women randomised to high (>100 μg) or low (<100 μg) cumulative epidural fentanyl had ultrasound gastric content assessment, measuring antral cross-sectional area (CSA) at epidural placement and 2 h thereafter (T2 h). MAIN OUTCOME MEASURES The primary outcome was CSA at T2 h comparing high-dose versus low-dose fentanyl. Secondary outcomes included change in CSA between baseline and T2 h. Sub-group analysis compared stomach content at T2 h according to baseline stomach content, empty (CSA <381 mm2) or full (CSA ≥381 mm2), and high-dose versus low-dose fentanyl. RESULTS Data from 80 women were analysed; 63 had empty and 17 had full stomach at baseline. There was no significant difference in CSA at T2 h between high-dose, mean 335 ± SD 133 mm2, versus low-dose fentanyl, mean 335 ± SD 172 mm2, P = 0.991. Change in CSA baseline to T2 h was 46 ± SD 149 mm2 for high and 49 ± SD 163 mm2 for low-dose group, P = 0.931. The subgroup analysis according to baseline stomach content showed no statistically significant differences in CSA at T2 h. CONCLUSION The CSA at T2 h was similar for women who received high-dose versus low-dose epidural fentanyl, measured by ultrasound, in our nonfasted labouring cohort. TRIAL REGISTRATION Clinicaltrials.gov number: NCT04202887.
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Affiliation(s)
- Elisheva Fiszer
- From the Department of Anaesthesia, Intensive Care and Pain, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel (EF, BA, YB, CFW)
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Restriction of oral intake during labor: whither are we bound? Am J Obstet Gynecol 2016; 214:592-6. [PMID: 26812080 DOI: 10.1016/j.ajog.2016.01.166] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 01/12/2016] [Accepted: 01/19/2016] [Indexed: 11/23/2022]
Abstract
In 1946, Dr Curtis Mendelson suggested that aspiration during general anesthesia for delivery was avoidable by restricting oral intake during labor. This suggestion proved influential, and restriction of oral intake in labor became the norm. These limitations may contribute to fear and feelings of intimidation among parturients. Modern obstetrics, especially in the setting of advances in obstetric anesthesia, does not mirror the clinical landscape of Mendelson; hence, one is left to question if his findings remain relevant or if they should inform current recommendations. The use of general anesthesia at time of cesarean delivery has seen a remarkable decline with increased use of effective neuraxial analgesia as the standard of care in modern obstetric anesthesia. While the American College of Obstetricians and Gynecologists now endorses clear liquids during labor, current recommendations continue to suggest that solid food intake should be avoided. Recent evidence from a systematic review involving 3130 women in active labor suggests that oral intake should not be restricted in women at low risk of complications, given there were no identified benefits or harms of a liberal diet. Aspiration and other adverse maternal outcomes may be unrelated to oral intake in labor and as such, qualitative measures such as patient satisfaction should be paramount. It is time to reassess the impact of oral intake restriction during labor given the minimal risk of aspiration during labor in the setting of modern obstetric anesthesia practices.
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Abstract
BACKGROUND Restricting fluids and foods during labour is common practice across many birth settings with some women only being allowed sips of water or ice chips. Restriction of oral intake may be unpleasant for some women, and may adversely influence their experience of labour. OBJECTIVES To determine the benefits and harms of oral fluid or food restriction during labour. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 June 2013) and reference lists of retrieved studies. SELECTION CRITERIA Randomised controlled trials (RCTs) and quasi-RCTs of restricting fluids and food for women in labour compared with women free to eat and drink. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the studies for inclusion, assessed risk of bias and carried out data extraction. MAIN RESULTS We identified 19 studies of which we included five, involving 3130 women. We excluded eight studies, one awaits classification and five are ongoing studies. All the included studies looked at women in active labour and at low risk of potentially requiring a general anaesthetic. One study looked at complete restriction versus giving women the freedom to eat and drink at will; two studies looked at water only versus giving women specific fluids and foods and two studies looked at water only versus giving women carbohydrate drinks.When comparing any restriction of fluids and food versus women given some nutrition in labour, the meta-analysis was dominated by one study undertaken in a highly medicalised environment. There were no statistically significant differences identified in: caesarean section (average risk ratio (RR) 0.89, 95% confidence interval (CI) 0.63 to 1.25, five studies, 3103 women), operative vaginal births (average RR 0.98, 95% CI 0.88 to 1.10, five studies, 3103 women) and Apgar scores less than seven at five minutes (average RR 1.43, 95% CI 0.77 to 2.68, four studies, 2902 infants), nor in any of the other outcomes assessed. Women's views were not assessed. The pooled data were insufficient to assess the incidence of Mendelson's syndrome, an extremely rare outcome. Other comparisons showed similar findings, except one study did report a significant increase in caesarean sections for women taking carbohydrate drinks in labour compared with water only, but these results should be interpreted with caution as the sample size was small. AUTHORS' CONCLUSIONS Since the evidence shows no benefits or harms, there is no justification for the restriction of fluids and food in labour for women at low risk of complications. No studies looked specifically at women at increased risk of complications, hence there is no evidence to support restrictions in this group of women. Conflicting evidence on carbohydrate solutions means further studies are needed and it is critical in any future studies to assess women's views.
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Affiliation(s)
- Mandisa Singata
- University of the Witwatersrand/University of Fort Hare/East London Hospital complexEffective Care Research UnitEast LondonSouth Africa
| | - Joan Tranmer
- Queen's UniversitySchool of NursingKingstonOntarioCanadaK7L 3K7
| | - Gillian ML Gyte
- The University of LiverpoolCochrane Pregnancy and Childbirth Group, Department of Women's and Children's HealthFirst Floor, Liverpool Women's NHS Foundation TrustCrown StreetLiverpoolUKL8 7SS
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Abstract
BACKGROUND Restricting fluids and foods during labour is common practice across many birth settings with some women only being allowed sips of water or ice chips. Restriction of oral intake may be unpleasant for some women, and may adversely influence their experience of labour. OBJECTIVES To determine the benefits and harms of oral fluid or food restriction during labour. SEARCH STRATEGY We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (April 2009). SELECTION CRITERIA Randomised controlled trials (RCTs) and quasi-RCTs of restricting fluids and food for women in labour compared with women free to eat and drink. DATA COLLECTION AND ANALYSIS Two authors independently assessed the studies for inclusion, assessed risk of bias and carried out data extraction. MAIN RESULTS We identified five studies (3130 women). All studies looked at women in active labour and at low risk of potentially requiring a general anaesthetic. One study looked at complete restriction versus giving women the freedom to eat and drink at will; two studies looked at water only versus giving women specific fluids and foods and two studies looked at water only versus giving women carbohydrate drinks.When comparing any restriction of fluids and food versus women given some nutrition in labour, the meta-analysis was dominated by one study undertaken in a highly medicalised environment. There were no statistically significant differences identified in: caesarean section (average risk ratio (RR) 0.89, 95% confidence interval (CI) 0.63 to 1.25, five studies, 3103 women), operative vaginal births (average RR 0.98, 95% CI 0.88 to 1.10, five studies, 3103 women) and Apgar scores less than seven at five minutes (average RR 1.43, 95% CI 0.77 to 2.68, three studies, 2574 infants), nor in any of the other outcomes assessed. Women's views were not assessed. The pooled data were insufficient to assess the incidence of Mendelson's syndrome, an extremely rare outcome. Other comparisons showed similar findings, except one study did report a significant increase in caesarean sections for women taking carbohydrate drinks in labour compared with water only, but these results should be interpreted with caution as the sample size was small. AUTHORS' CONCLUSIONS Since the evidence shows no benefits or harms, there is no justification for the restriction of fluids and food in labour for women at low risk of complications. No studies looked specifically at women at increased risk of complications, hence there is no evidence to support restrictions in this group of women. Conflicting evidence on carbohydrate solutions means further studies are needed and it is critical in any future studies to assess women's views.
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Affiliation(s)
- Mandisa Singata
- Effective Care Research Unit, University of the Witwatersrand/University of Fort Hare/East London Hospital complex, East London, South Africa
| | - Joan Tranmer
- School of Nursing, Queen’s University, Kingston, Canada
| | - Gillian ML Gyte
- Cochrane Pregnancy and Childbirth Group, Department of Women’s and Children’s Health, The University of Liverpool, Liverpool, UK
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Gennaro S, Mayberry LJ, Kafulafula U. The evidence supporting nursing management of labor. J Obstet Gynecol Neonatal Nurs 2008; 36:598-604. [PMID: 17973705 DOI: 10.1111/j.1552-6909.2007.00194.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Although nursing practice is responsive to research findings, the practice site in which a nurse works has an impact on the ability to incorporate research changes into practice in a timely fashion. This review of the evidence base for nursing management of labor care focuses on care that typically falls within the nurses' domain and highlights the evidence in five areas in which there is research on patient preferences. These include management of admission and of progression during the first stage of labor, fetal monitoring, care and comfort practices during labor, and the management of second-stage labor. Directions for achieving progress toward practice change are highlighted.
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Affiliation(s)
- Susan Gennaro
- College of Nursing, New York University, NY 10003, USA.
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Parsons M, Bidewell J, Griffiths R. A comparative study of the effect of food consumption on labour and birth outcomes in Australia. Midwifery 2006; 23:131-8. [PMID: 17011681 DOI: 10.1016/j.midw.2006.03.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2005] [Revised: 03/04/2006] [Accepted: 03/13/2006] [Indexed: 11/22/2022]
Abstract
OBJECTIVE to explore the effect of volitional food consumption by women during labour on labour and birth outcomes. DESIGN a comparative design using concurrent controls. SETTING four public hospitals in Sydney, Australia. PARTICIPANTS 217 English-speaking, nulliparous women with low-risk pregnancies. The sample was divided into four sub-groups identified post hoc from reported behaviour: (1) 82 women who chose to eat food during early labour only; (2) 10 who ate during established labour only; (3) 31 who ate during early and established labour and (4) 94 who chose to consume clear fluids only during early and established labour. INTERVENTIONS voluntarily eating food during labour compared with voluntarily consuming clear fluids only. MEASUREMENTS differences between the four eating groups were examined for labour progress using one-way analysis of variance (ANOVA). A hierarchical multiple regression tested the association between eating during labour and labour duration. The relationship between food intake and the incidence of medical interventions was tested using chi(2) tests. FINDINGS eating during the early phase of the first stage of labour was associated with M=2.16 hrs longer labour (p<0.01). When women ate food during both their early and established phases of labour, M=3.5 hrs was added to their labour (p<0.01). The incidence of vomiting, medical interventions during labour or adverse birth outcomes were unaffected by food intake. CONCLUSION the findings suggest that women should be informed that labour may take longer when they eat food. However, eating does not seem to affect other labour or birth outcomes. IMPLICATION FOR PRACTICE the findings challenge the belief among many midwives that food intake is beneficial to labour progress. However, women should not be denied food for fear of vomiting or because it may make labour longer. Women with low-risk labours should be informed of the risk, although rare, of aspiration if general anaesthesia is required, and be allowed to respond to their natural desires for oral intake during labour.
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Affiliation(s)
- Myra Parsons
- University of Western Sydney, School of Nursing, Family and Community Health, Parramatta, Australia.
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Tranmer JE, Hodnett ED, Hannah ME, Stevens BJ. The effect of unrestricted oral carbohydrate intake on labor progress. J Obstet Gynecol Neonatal Nurs 2005; 34:319-28. [PMID: 15890830 DOI: 10.1177/0884217505276155] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To determine if unrestricted oral carbohydrate intake during labor reduced the incidence of dystocia in low-risk nulliparous women. DESIGN AND SETTING A randomized clinical trial at a university-affiliated hospital in southeastern Ontario. Low-risk nulliparous women were randomized between 30 and 40 weeks gestation to either an intervention or usual care group. INTERVENTION Women in the intervention group received, prenatally, guidelines about food and fluid intake during labor and were encouraged to eat and drink as they pleased during labor. Women in the usual care group received no prelabor information and were restricted to ice chips and water during labor in the hospital. MAIN OUTCOME MEASURE The incidence of dystocia, defined as a cervical dilatation rate of less than 0.5 cm/hr for a period of 4 hrs after a cervical dilatation of 3 cm. RESULTS Three hundred twenty-eight women were randomized to the intervention (n = 163) or usual care (n = 165) groups. Women in the intervention group reported a significantly different pattern of oral intake during early labor in the hospital (chi(2) = 40.7, p < .001). The incidence of dystocia was 36% (n = 58) in the intervention group and 44% (n = 72) in the usual care group and was not significantly different (OR = 0.71, 95% CI = 0.46, 1.11). There were no significant differences in the other secondary outcomes or in the incidence of adverse maternal or neonatal complications. CONCLUSION Eating and drinking early in labor had no significant impact on the incidence of dystocia and/or adverse maternal or neonatal outcomes.
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Affiliation(s)
- Joan E Tranmer
- Nursing Research Unit, Kingston General Hospital, Kingston, Ontario, Canada K7L 2V7.
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Parsons M. A midwifery practice dichotomy on oral intake in labour. Midwifery 2004; 20:72-81. [PMID: 15020029 DOI: 10.1016/s0266-6138(03)00055-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2002] [Revised: 05/29/2003] [Accepted: 07/08/2003] [Indexed: 11/20/2022]
Abstract
OBJECTIVE to assess the views and practices of midwives regarding oral intake in labour for women with low-risk pregnancies. DESIGN an exploratory survey design including open- and closed-ended questions. SETTING four hospitals in Sydney, Australia. PARTICIPANTS 89 practising midwives who provided care for labouring women. FINDINGS midwives were divided on the issue of what and when labouring women should, or should not, be allowed to eat and drink. The views and practices of these midwives were influenced by the accepted practice in the hospital in which they were employed and the types of midwifery models in which they have practised. KEY CONCLUSIONS there is insufficient conclusive research evidence to support any stance on oral intake for labouring women. Most information purported by supporters of oral intake is based on anecdotal evidence and assumptions based on the physiology of the body. 'Nil by mouth' policies have never been researched while clear fluid policies are based on research performed with non-obstetric patients. IMPLICATIONS FOR PRACTICE without reliable research evidence for the management of oral intake for labouring women no hospital practice or policy is valid. This leaves midwives with the responsibility of deciding what they believe is the best management for the oral intake of labouring women in their care.
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Affiliation(s)
- Myra Parsons
- 23 Mansfield Road, Galston, NSW 2159, Australia.
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Parsons M. Midwifery dilemma: to fast or feed the labouring woman Part 2: the case supporting oral intake in labour. ACTA ACUST UNITED AC 2004; 17:5-9. [PMID: 15079979 DOI: 10.1016/s1448-8272(04)80018-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
This article has, so far, explored the phenomenon of aspiration associated with obstetric general anaesthesia (see Part 1). Part 2 examines the literature pertaining to the history of dietary regimes for labour and the physiological and psychological effect of restricting or allowing food and fluids during labour. The increasing trend among some health professionals to allow food and fluids during labour and research conducted to investigate the effect of the labouring woman's oral intake on the labour and birth outcomes is also discussed.
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Singata M, Tranmer J. Restricting oral fluid and food intake during labour. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2002. [DOI: 10.1002/14651858.cd003930] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Sommer PA, Norr K, Roberts J. Clinical decision-making regarding intravenous hydration in normal labor in a birth center setting. J Midwifery Womens Health 2000; 45:114-21. [PMID: 10812856 DOI: 10.1016/s1526-9523(99)00047-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Intravenous hydration (IVH) in normal labor is used routinely in most hospital settings despite the lack of support from recent research. However, it is not used routinely at one in-hospital, Alternative Birthing Center (ABC), in the Midwest. The purpose of this study was to explore and describe the criteria and perspectives of the certified nurse-midwives (CNMs) and nurses (RNs) in their decision-making process toward nonroutine use of IVH. In-depth interviews with five CNMs and four RNs that work in the ABC provided insight into how they balanced patient preference, research-based knowledge, and clinical judgments, in making decisions about IVH. The RNs were slightly more in favor of IVH than the CNMs, but not because of philosophic differences. Rather, the different roles and responsibilities of CNMs and RNs seemed to be most important. CNMs had a stronger commitment to client preferences, whereas RNs were more concerned about their responsibility for efficiently starting IVs prior to an emergency situation. Understanding professional differences in the decision-making process for IVH can enhance clinical functioning of the caregiving team by helping CNMs anticipate and address potential conflicts.
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Newton C, Champion P. Oral intake in labour: Nottingham's policy formulated and audited. ACTA ACUST UNITED AC 1997. [DOI: 10.12968/bjom.1997.5.7.418] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Newton N, Newton M, Broach J. Psychologic, physical, nutritional, and technologic aspects of intravenous infusion during labor. Birth 1988; 15:67-72. [PMID: 3291888 DOI: 10.1111/j.1523-536x.1988.tb00807.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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